15398 POST THIS CARD NEAR FRONT OF BUILDING
e � PERMIT NUMBER
CITY OF CUPERTINO 15398
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS l66 �� Me�ca,9- .�� UNIT# _LOT#
� PERMIT EXPIRES IF WORK
OWNER O�i+�r/L"iC. CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VAI_I DATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING c !
ELECTRICAL ISSUANCE DATE
MECHANICAL - BLDG ELECT I PLO. MECR
BUILDING PERMIT
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED INFORMATION
WOOD FLOOR VALUATION slFr.
PLUMBING Up—Jy
MECHANICALB _
�Nr� � PERM1IIi iU l
ELECTRICAL p\ � }' • '\ f'L. ' //_).
FRAMING - \`` ..,.hC
- C\�O.� v-• sroRles rvPE corvsrR
INSULATION
occ GROUP DES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO Vi FLOOR ARIIA i0 i4L ALIiLAGh
;. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USI:
ROOF SHEATHING RES IND CON PB (111-1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.k
PLUMBING ELECT.ENERGY
TRACT NO, PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC.FILE No
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FINE SPR INK ENERGY D]E
MECHANICAL Y ❑ N[] v ❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD/ONE ALUc.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. v ❑ N❑ v ❑ No
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING
INTERIOR LATH TEMPORAR APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING f
o0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coNST.TAx
PLEASE READ REVERSE SIDE BEFORE . TOTAL
CALLING FOR FINAL INSPECTION.
1
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENT[FICATI ONPERMIT NUMBER
BUILDING APPLICATION & PERMIT 15398
75A �
�- 2 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER 5 PLAN CHECK VALIDATION
PHON
(`
NAME TY. ELECTRIC PERMIT FEE
c E /�I L
Q
orv7ancToas UTLETS-SWITCHES-RECEP 10.00/1.00
TIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
A DOREss
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
L.C.No. - SIGNS TRANS. 3.00 -
ARC
H.OREND, SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00
ArS MOTORS SEE FEE SCH. �n -
ADDRESS ESS -OLt/-�F-/
SERVICE CHANGE 20.00
Cie.,
o LICENSIi1)CON'T'RACTORS DECLARATION �///��/ Y�t+
U v 1 herchy affirm Ilial 1 am licensed under provisions of Chapter 9 tSSUANCE`GATE
m< m (Commencing with Se'lion 7000)of Division 3 01 the Business and BLDG. I ELECT. -PLG. -M CH.
H N z Professions Code,and my license is in full force and effect. ❑ ❑ O
Z o m - License Class Lic.Number
4 z H°w Dale Contract.,
a y'y BUILDING PE MIT
Ie w a OWNER-BUILDER DECLARATION INFORMATION
woAO MISC. REFERTOORD
I hereby affirm that I an,exempt fmn,the Contour.",License VALUATION $/FT.
F LL o a Law for the following reason.(Sec 7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which e(plireS a Permit to construct,alter,
ce au¢ 2O improve,demolish.Or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O K rcquires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w m as he is licensed pursuant to the provisions(it the Contractors License
F z Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt Therefrom and QTY. PLUMBING PERMIT FEE
acro (lie basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ;m byany applicant for a permit subjects tic applicant ton civil penalty gLTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(SSOOIJ:
❑ 1,as owner of One property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves Thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself Or through his own employees.provided that such improve-
ments are not intended or offend for sale If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of c.ngtetion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build lir im-
proveforpurposeofsele.). INDUSTRIAL WASTE INTER. 30.00 RES lao CON PER One,
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Seo. 7044,Business LAWN SPRINKLERS-11 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to un owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.2001`1/10.00 Id TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&ItC.Tim this WATER HEATER W/VENT, 6.00
rea""
Owoc __-- [ a't,.-. WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMP�DECLARATION WATER TREATING EQUIP. }a - 5.00
1 hereby infirm that I have IT certificate of consent to self-insure,or a curllficate of Workers'Compensation Insurance or a certified ZONING ENG.SITE NO.
copy thercol'(Sce.3800,LAC.).
Policy No. Company Vs4!
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with (he city inspection division. MISC.- ' REFER TO ORD.
0 Applicant Y ❑ N❑ Y C] N❑
jrrn CER"1'IFICA'I'E 01:EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 (J - FLOOD ZONE A.L.U.C.V V
ELI COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. _7e- rl�. ❑ ❑ E] N❑
d ❑ !'Phis section need not be Completed if the permit is for one TOTAL CJC N
Z hundred dollars(S 100)or lues.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued.1 shall not employ any person in any manner so as m
O W become subject t.the Workers'C. u
mpaatic n Laws of California.
Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} Vo'i NOTICE TO APPLICANT. If,after making this Certificate of 1:
? en.pticn,you should become subject to tine Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this pern..t shall be declined revoked. AIR HANDLING UNIT(TO 109MC.F.M.) 4,00
CONSTRUCPION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE
I hereby affirm, that there is a construction lending agency far EXHAUST HOOD(WITH DUCT) 5.00
the performance of tire work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.): HEATING UNIT ITU 100,000 B.T.U.) 8.00
Lender,Name HEATING UNIT IO VER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and Stam that the above VENTILATION FAN (SINGLE) 4.00
information is correct, I agree to comply with all city and county gO1LER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and Slate laws relating to building construction, and
herchy authorise representatives of this city to enter upon the 601 LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertinu against liabilities,judgments, costs and expenses which' CONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ranting of this pcnniL MECH.CONT. LIC.NO. MECH.
��-.F TOTAL TOTAL
Sign to pphtor
canl/Cont cDate V
OFFICE COPY